Postpartum bleeding: Is it normal to not experience bleeding after delivery?

Postpartum bleeding: One of the most concerning reasons for the absence of lochia is retained placental fragments. (Image: Canva)

Postpartum bleeding, also known as lochia, is a common experience for women following childbirth. It typically lasts for several weeks and gradually transitions from heavy bleeding to lighter spotting. However, some women may not experience significant bleeding after delivery. While it may seem like a blessing, the absence of postpartum bleeding can sometimes indicate underlying issues. A deep understanding of this problem, highlighting potential causes and when to seek medical attention is the way out for sound health.

Normal postpartum bleeding

Before delving into the reasons for the absence of bleeding, it’s essential to understand what constitutes normal postpartum bleeding. Lochia consists of blood, mucus, and uterine tissue shed as the uterus heals and returns to its pre-pregnancy size. Typically, it progresses through three stages according to Dr Kiran Yadav, senior consultant - obstetrician & gynecology, Gurgaon.

Lochia rubra: This initial stage lasts for about 3-4 days post-delivery and involves heavy bleeding with bright red blood.

Lochia serosa: Over the next 4-10 days, the bleeding decreases in volume and changes to a pink or brownish color.

Lochia alba: In the final stage, lasting from day 10 up to 6 weeks, the discharge becomes yellow or white and is mostly mucus.

Reasons for absence of postpartum bleeding according to Dr Yadav

Retained placental fragments

One of the most concerning reasons for the absence of lochia is retained placental fragments. When parts of the placenta or membranes remain in the uterus after delivery, they can prevent normal postpartum bleeding and lead to infection or hemorrhage.

Women may experience uterine tenderness, fever, and foul-smelling discharge. An ultrasound can help diagnose this condition, and treatment typically involves a surgical procedure called dilation and curettage to remove the retained tissue.

Uterine atony

Uterine atony occurs when the uterus fails to contract adequately after delivery, leading to insufficient shedding of the uterine lining.

This condition may result in a distended, soft uterus and minimal bleeding. Immediate medical intervention is necessary, as uterine atony can cause severe hemorrhage once the bleeding starts.

Cervical stenosis

Cervical stenosis, or the narrowing of the cervical canal, can impede the normal flow of lochia.

Women may experience cramping and pelvic pain due to the trapped blood. Diagnosis often involves a pelvic exam and imaging studies, and treatment may include cervical dilation to allow normal passage of the lochia.

Blood clot formation

In some cases, large blood clots can form and block the cervical canal, preventing lochia from being expelled.

The presence of clots can cause pelvic pain and a feeling of fullness. Manual removal or medication to help break down the clots may be necessary.

Previous uterine surgery or scarring

Women with a history of uterine surgery, such as a cesarean section or myomectomy, may experience altered postpartum bleeding patterns due to scarring.

Scarring can disrupt the normal shedding of the uterine lining, leading to minimal bleeding. Medical evaluation is needed to determine the extent of scarring and appropriate management.

When to seek medical attention

While the absence of postpartum bleeding can occasionally be benign, it is crucial to seek medical evaluation if accompanied by the following symptoms:

Fever or chills, indicating a possible infection
Severe pelvic pain or cramping
Foul-smelling discharge
Feeling of fullness or pressure in the pelvic area

Understanding the reasons behind the absence of postpartum bleeding is essential for new mothers. While some causes may be harmless, others require prompt medical attention to prevent complications.